| NPI | 1598883787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KS 05-34953) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 5101016560) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NE 850) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2013-04-08 |